Overview
Depressive disorders cause huge burdens on the level of the individual as well as the society. Major depressive disorder is the most prevalent psychiatric disorder with catastrophic consequences including disability and death. However, communicating with depressed clients exhibits specific challenges and requires skillful execution. Depressed clients may be less likely to ask questions or advocate for themselves. You as a nurse play a huge role in gathering crucial information from clients and performing this skillfully promotes change and improves client outcomes.
Marvin, a 29-year-old African-American male was voluntarily admitted to the inpatient psychiatry unit after a suicide attempt by asphyxiation through carbon monoxide that was aborted by his roommate.
His past psychiatric history includes major depressive disorder with anxious features. His chart states his mental health concerns started many years ago and that he had been receiving treatment for the past 4 years. He denied a history of other psychiatric disorders. With this latest attempt, his parents stated he posted suicidal thoughts on social media a few weeks prior.
His past medical history included mild obesity. He does not use tobacco, alcohol, or other recreational substances.
His current depressive episode began approximately 14 months prior to admission when he experienced significant psychosocial stressors at work and, without seeking medical assistance, discontinued his antidepressant treatment (escitalopram). Since that time, he experienced persistent negative thoughts and suicidal ideation, difficulty coping, low mood, guilt, irritability, and worry. Six months prior to admission he independently re-initiated his escitalopram which was self-reported to have reduced his irritability and temper. He achieved some stability in his mental health until 1 month prior to admission when, without an identifiable trigger, he experienced a sudden decline in his mood which culminated in a suicide attempt.
On admission, Marvin reported feeling numb, a loss of joy and interest in activities, and difficulty coping. It appears he hasn’t showered in several days, if not more. He has spent the entire evening in his room, sleeping since arriving onto the unit.
Tasks
Use Marvin’s scenario to address the following:
How would you as the nurse respond therapeutically to a depressive ruminative thought?
How would you assess Marvin’s behaviors?
What communication techniques and guidelines would you incorporate in interacting with Marvin?
Which neurovegetative symptoms of depression is Marvin exhibiting? What in his behavior supports these symptoms? How would these symptoms differ if Marvin experienced atypical vegetative syndrome?
What kind of questions could you ask to elicit if Marvin has low physical energy?
What kind of questions could you ask to elicit if Marvin is suicidal?
As Marvin’s friends and family come to visit him, how would you advise them of Marvin’s condition?
Respond to the prompts in a 2 – 3 page document, including references.
Therapeutic Response to Depressive Ruminative Thought
As a nurse, responding therapeutically to a depressive ruminative thought is crucial in supporting the client and promoting positive change. Here are some strategies to consider:
Active Listening: Show genuine interest and empathy by actively listening to Marvin’s thoughts and feelings. Reflect back what he says, using statements like, “It sounds like you’re feeling overwhelmed with negative thoughts.”
Validation: Validate Marvin’s experiences and emotions. Let him know that his feelings are valid and that he is not alone in his struggles. For example, you could say, “It’s understandable that you feel this way given the challenges you’ve been facing.”
Cognitive Restructuring: Help Marvin challenge his negative thoughts and replace them with more positive or realistic ones. Encourage him to identify alternative explanations or perspectives. For instance, you could ask, “What other explanations could there be for this situation?”
Problem-Solving: Assist Marvin in identifying practical solutions to the problems he is facing. Help him break down overwhelming tasks into smaller, manageable steps. Collaborate on creating an action plan to address his stressors.
Reframing: Encourage Marvin to reframe his negative thoughts into more positive or neutral ones. Help him identify strengths, successes, and positive aspects of his life. For example, you could say, “What are some things that have gone well for you recently?”
Mindfulness Techniques: Teach Marvin mindfulness techniques such as deep breathing exercises, progressive muscle relaxation, or guided imagery to help him focus on the present moment and reduce rumination.
Remember to provide a safe and non-judgmental environment for Marvin to express his thoughts and emotions. Building trust and rapport is essential in supporting his journey towards recovery.
Assessment of Marvin’s Behaviors
To assess Marvin’s behaviors, observe and document his actions, expressions, and interactions. Some areas to assess include:
Physical Appearance: Note his grooming, hygiene, and overall appearance to identify any signs of neglect or self-care difficulties.
Social Interaction: Observe how Marvin interacts with others, including staff, fellow patients, and visitors. Look for signs of withdrawal, isolation, or difficulty initiating or maintaining conversations.
Activity Level: Assess if Marvin engages in activities or shows interest in participating in therapeutic interventions or recreational activities offered in the unit.
Sleep Patterns: Document Marvin’s sleep duration, quality, and any disturbances he reports.
Appetite and Weight Changes: Monitor his eating habits and document any changes in appetite or weight.
Psychomotor Activity: Observe for any psychomotor agitation or retardation, such as restlessness or slowed movements.
Verbal Expression: Listen for any indications of low mood, pessimism, hopelessness, guilt, or suicidal ideation during conversations with Marvin.
It is important to conduct these assessments regularly to monitor changes in Marvin’s behaviors and identify any worsening of depressive symptoms or potential risk factors.
Communication Techniques and Guidelines for Interacting with Marvin
When interacting with Marvin, utilize effective communication techniques to establish rapport and support his emotional well-being:
Active Listening: Give your full attention to Marvin and demonstrate empathy while he expresses his thoughts and feelings.
Open-Ended Questions: Use open-ended questions to encourage Marvin to share more about his experiences and emotions. This allows for a deeper understanding of his struggles.
Non-Judgmental Attitude: Create a safe space where Marvin feels comfortable expressing himself without fear of judgment or criticism.
Reflective Responses: Reflect back what Marvin shares to show that you understand and validate his emotions. This helps build trust and a therapeutic relationship.
Empathy and Validation: Show empathy towards Marvin’s struggles and validate his experiences by acknowledging his emotions as real and understandable.
Encouragement and Support: Provide encouragement and support by highlighting his strengths, progress, or positive coping strategies he has used in the past.
Remember to maintain confidentiality and privacy during conversations with Marvin, ensuring that he feels safe opening up about his experiences.
Neurovegetative Symptoms of Depression Exhibited by Marvin
Marvin exhibits several neurovegetative symptoms of depression:
Sleep Disturbance: His inability to sleep and spending the entire evening sleeping upon admission indicates disrupted sleep patterns commonly associated with depression.
Loss of Interest or Pleasure: Marvin reports feeling numb and a loss of joy and interest in activities he once enjoyed, which is consistent with anhedonia - the diminished ability to experience pleasure seen in major depressive disorder.
Changes in Appetite: Although not explicitly mentioned in the scenario, changes in appetite are often associated with depression - either increased (comfort eating) or decreased (lack of appetite).
Psychomotor Retardation: Marvin’s lack of motivation and spending the entire evening in his room sleeping may suggest psychomotor retardation - a slowing down of physical movements often seen in depression.
If Marvin were experiencing atypical vegetative syndrome instead, he would exhibit symptoms such as increased appetite, weight gain, hypersomnia (excessive sleepiness), and heavy limbs.
Questions to Elicit if Marvin has Low Physical Energy
To assess if Marvin has low physical energy associated with depression, you could ask the following questions:
“Have you noticed a decrease in your energy levels lately?”
“Do you find it difficult to motivate yourself to do everyday tasks?”
“Are there times when you feel physically tired even though you haven’t engaged in any strenuous activities?”
“Have you noticed any changes in your ability to concentrate or complete tasks due to fatigue?”
“Do you feel physically drained even after getting enough sleep?”
These questions can help determine if Marvin is experiencing fatigue or low physical energy levels associated with depression.
Questions to Elicit if Marvin is Suicidal
When assessing if Marvin is suicidal, it is crucial to ask direct questions using a sensitive approach:
“Have you had any thoughts about ending your life?”
“Have you made any specific plans to harm yourself?”
“Do you have access to any means that could be used for self-harm?”
“Have you ever attempted suicide before?”
“Do you feel like life is worth living right now?”
These questions should be asked in a non-judgmental manner while ensuring that appropriate safety measures are implemented based on the assessment findings.
Advising Friends and Family about Marvin’s Condition
When advising friends and family about Marvin’s condition, it is important to prioritize confidentiality while providing them with information that promotes understanding and support:
Privacy Concerns: Explain the importance of maintaining confidentiality regarding Marvin’s diagnosis and treatment plan unless he provides consent for specific individuals to be informed.
General Information: Educate friends and family about depression as a mental health condition, emphasizing its impact on mood, behavior, and daily functioning.
Supportive Role: Encourage friends and family to offer emotional support by listening without judgment, engaging in positive communication, and encouraging Marvin’s involvement in treatment.
Safety Awareness: If necessary, inform friends and family about potential warning signs of suicidal ideation or self-harm behaviors so they can be vigilant and seek professional help if needed.
Encouraging Professional Involvement: Discuss the importance of professional mental health care and encourage friends and family members to support Marvin’s engagement with treatment providers.
Community Resources: Provide information about local mental health resources such as support groups or counseling services that friends and family can access for their own support or education.
By advising friends and family about Marvin’s condition sensitively and promoting their understanding, they can play a supportive role in his recovery process while respecting his privacy and dignity.
References: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.: Author. Halter, M.J., & Varcarolis, E.M. (2020). Varcarolis’ foundations of psychiatric mental health nursing: A clinical approach (9th ed.). St Louis, MO: Elsevier/Saunders. National Institute of Mental Health (2019). Depression - What You Need To Know [Brochure]. Retrieved from https://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know/index.shtml